Professional Documents
Culture Documents
a female fetus who is exposed to influenza has a higher risk for shizophrenia than a male fetus
males show significantly more structural brain abnormalities from perinatal or early childhood trauma than females
do
1.4 onset and course of disease
rare onset in children
persons who have later onset have better outcomes in all areas
approx 80% of people w/ schizophrenia had an early onset, whereas 20% have a late onset (after 40) or very late
onset (after 60).
Course of illness
premorbid: social, motor, cognitive changes
Prodromal: 1 month to 1 year before dx/S&S of this phase include
mood symptoms (anxiety, irritability, dysphoria, anguish)
cognitive symptoms (distractibility, concentration, difficulties, disorganized thinking)
obsessive behaviors
social withdrawal & role functioning deterioration
sleep disturbances
attenuated (weaker) positive symptoms (illusions, ideas of reference, magical thinking, superstitiousness)
Psychotic: acute, recovery/maintenance, stable phases
acute- florid positive symptoms (delusions, hallucinations) negative symptoms (apathy, withdrawal,
avolition). Unable to perform self-care activities, brief hospitalization required.
Recovery/maintenance- 6-18 mo. After acute treatment. Less severe symptoms. Able to take care of
themselves w/ some supervision.
Stable- symptoms are in remission. Residual symptoms (milder forms of symptoms). May live
independently in the community.
1.5 subtypes & related disorders of schizophrenia
Paranoid
Better prognosis/less cognitive & neurological impairments
respond better to meds
in acute phase more a danger to self or others
suspicious of others
touch & personal space should be considered
must meet 2 of the symptoms in criterion A: also listed on pg 270
presence of delusions & hallucinations.
The other diagnostic criteria (I.e disorganized speech, behavior, & other negative symptoms) are not
prominent.
Disorganized (formerly called hebephrenic)
severe disorganization in speech, odd behaviors
socially withdrawn
poor grooming
prognosis is poor
word salad (communication that includes both real & imaginary words in no logical order)
Catatonic
psychomotor disturbances catalepsy (waxy flexibility)
catatonic stupor (psychomotor retardation) or excitement (psychomotor excitation)
require the most nursing care due to chronic vegetative state can see & hear physical care
to meet the criteria, p/t must show two of the following behaviors:
motor immobility
excessive motor activity
extreme negativism (resistance to all instructions & attempts to be moved)
peculiar voluntary movements (grimacing. Sterotypic movements, posturing)
echopraxia (imitating the movement of others) OR echolalia (repeating what was said by another)
Undifferentiated
prognosis poor & chronic
does not fit other types
extreme delusions & odd behavior
Residual
free of prominent symptoms but still some negative
may continue for years w/ or w/o exacerbation
dx criteria:
absence of prominent delusions, hallucinations, disorganized speech, disorganized or catatonic behaviors.
Continuing evidence of the presence of negative symptoms or reduced positive symptoms
Related disorders
Schizoaffective: a condition in which a person experiences a combination of schizophrenia symptoms such as
hallucinations & delusions & of mood disorder symptoms such as mania & depression
later onset
severe mood swings
some psychotic symptoms
better prognosis
treatment is based on presenting symptoms
depressed phase like major depression
manic phase like bipolar manic
psychotic more like schizophrenia
diagnosis: Bleuler's fundamental signs
affect (feeling)
associative looseness (speech)
autism (thinking)
ambivalence (behavior)
Schizophreniform
Defining characteristics same as those of schizophrenia w/ 2 exceptions: duration (at least 1 mo. But less than 6
mo.) & impairment function.
Prognosis: functional capacity is high.
Delusional
fixed false belief is not bizarre, that it may seem plausible, & that it lasts more than a month w/ causing obvious
impairment in functioning.
Stalking behaviors
jealousy w/ evidence
sadness, grief, irritability, legal problems
Brief psychotic
lasts less than a month
may have delusions, hallucinations, incoherent speech, grossly disorganized & confusing dysfunctional behaviors.
Symptoms not r/t to substance abuse or meds
associated w/ stressors
young adults who are high risk for suicide
care must focus on saftey & attention to the basic needs of nutrition & hygiene.
Shared psychotic (Folie a Deux)
a person may share the same delusions w/ another person.
If primary person is a parent, affect children may literally grow up w/ the delusions.
Psychotic D. due to a general medical condition
high fever caused by a kidney infection may induce hallucinations, confusion, disorganization, aggressive or
bizarre behavior.
Strokes, fluid & electrolyte imbalances, SLE, hypoxia, encephalitis, hypoglycemia.
Best approach is to assume that psychosis is a manifestation of an underlying & undiagnosed medical problem
until it is proven otherwise
Substance-induced Psychotic D.
tactile hallucinations (insects crawling over the skin) are characteristic of alcohol & drug abuse.
Symptoms usually resolve within a month.
Persons of psychosis may use drugs & alcohol as a method of self-medicating.
Psychotic disorder not otherwise specified
etiology of psychotic behaviors is unclear
1.6 positive & negative symptoms
Negative
interfere w/ the ability to initiate or maintain relationships, conversations, hold a job, make decisions, & maintain
ADLs.
Not as obvious
more insidious onset
more debilitating
contributes to social/occupational functioning
blunted or flat affect
Anhedonia- lack of pleasure
anergia- lack of energy
avolition- lack of motivation
depression, hopeless (risk for suicide)
social isolation
decreased spontaneity
poor response to 1st generation antipsychotics (may actually worsen)
Positive
delusions, persecutory or grandiose
delusions of being controlled
mind-reading or thought-insertion ideas
perceptual: hallucinations, auditory or other sensory modes
bizarre dress & behavior
thought disorganization & tangential (superficial) speech
aggressive & agitated behavior
pressured speech
presence of suicidal ideation
ideas of reference
respond well to treatement & reduced stressors
1.7 nursing process
Assess
what problems have you been having recently
do you now or have you ever used alcohol or drugs
have you heard (sounds, voices, or messages) seen (lights, figures) smelled (strange, bad, good odors) tasted
(strange, bad, or good tastes) or felt (touching, warm , or cold sensations) anything that others who were
present did not
what are the voices like that you hear
it sounds like you're very scared right now
I don't hear any other voices but yours & mine
what helps to make the voices go away or get quieter
let's see if doing something (walking , crafts, singing etc.) helps with the hallucinations.
Nursing dx
based on the assessment of positive or negative symptoms
risk for suicide, risk for self-directed & other directed violence
disturbed sensory perception & thought processes
self-care deficit
outcomes
safety always priority
vary w/ phase of illness & c/t
measurable, behavioral & realistic
demonstrate an absence of suicidal behaviors or violent behaviors toward others
demonstrate an absence of self-mutilating behaviors
nursing interventions
specific to the symptom
aimed at lowering anxiety
decreasing defensive patterns
encouraging participation
raising self-esteem
agitated c/ts
SAFETY
reduce stimulation
brief , concise , not abstract statements
what are the stressors/triggers
redirect come walk w/ me, tell me what is going on
prevent aggression c/ts always give signs, just look
acute phase
crisis intervention
stabilization
safety
limit setting
maintenance/stable phase
teach symptoms management
small amounts of info, can't tolerate lots of detail, use pictures
prevent relapse
1.8 shift to community treatment
assertive community treatment teams
designed specifically for the individuals strengths & deficits.
Deliver care 24/7
help w/ ADLs & job seeking skills & placement & offering support
family interventions, supported employment, CBT, social skills training, early intervention programs
group therapy, group homes.
therapeutic methods to prevent violence psychopharmacology, somatic therapy, milieu therapy, behavior modification
1.9 psychopharmological management
typical/conventional antipsychotic/1st generation
work by blocking the D2 dopamine receptors in the limbic region of the brain
Phenothiazines: Chlorpromazine (Thorazine) (first drug to treat psychosis in the 50s), Thioridazine (Mellaril),
Trifluoperazine (stelazine) & Fluphenazine (Prolixin)
most effective for treating positive psychotic symptoms only
has many side effects which causes clients to stop taking them
blocks dopamine in the motor centers (Extrapyramidal Nerve tract) causes movement disorders or
EPSincluding Tardive dyskinesia (a neurologic syndrome that consists of abnormal, involuntary,
irregular choreoathetoid movements of the muscles, the head, the limbs and trunk)
choreoathetosis is the occurrence of involuntary movements in a combination of chorea (irregular
migrating contractions) & athetosis (twisting & writhing)
-manifested by tongue protrusion, puffing of the cheeks, chewing or puckering of the mouth
-occurs rarely, but may be irreversible
AIM scale (autonomic involuntary movement scale)- performed not less than every 6 months when a p/t
is taking either typical or aytypical antipsychotics
then came Butyrophenons: Haloperidol (haldol)
others: Thiothixene (Navane)
Extrapyramidal symptoms: serious reactions that appear r/t to high dose of neuroleptic meds
Akathisia- subjective feeling of muscular discomfort that causes the p/t to become agitated, pace, alternately sit &
stand & feel a lack of control
Parkinsonian- muscle stiffness, cogwheel, rigidity, shuffling gate, perioral tremor, hypersalvation, & mask like
expression
acute dystonias-spasmodic movements caused by slow, sustained, involuntary muscle contractions such as:
torticollis (abnormal, asymmetrical head or neck position)
opisthotonos ( body is rigid & arches the back, w/ the head thrown backward)
oculogyric crisis ( prolonged involuntary upward deviation of the eyes)
EPS can involve the neck, jaw, tongue or entire body
Drugs of treatment:
Antiparkinson drug Benztropine (cogentin), trihexyphenidyl (Artane)
Acute emergencies Acute dystonic reactions, NMS (neuroleptic malignant syndrome)
Tardive dyskinesia life-threatening irreversible sweating, fever, unstable bp, stupor, muscle rigidity,
autonomic dysfunction, elevated CPK, excessive salvation, occurs in 1% but 10% die
other side effects of typicals:
anticholinergic (dry mouth, blurred vision, urinary retention, nasal congestion, constipation, ejaculatory
inhibition)
sedation (most common during early stage of treatment, need to avoid alcohol, antihistamines, & sleeping
aids)
postural hypotension
arrhythmias, palpitations, & prolonged QT intervals
lowered seizure threshold
weight gain increased risk for type II diabetes
photosensitivity & skin changes
poikilothermia loss of ability to regulate internal body temp. watch older adults in hot weather
galactorrhea & gynecomastia breast enlargement or tenderness
cholestatic jaundice
Atypicals- Clozoril (clozapine) was the first in the 90s
1st to effectively treat both + & - symptoms of schziophrenia
not used as a first resort due to risk for agranulocytosis ( bone marrow does not make enough of a certain type
of mature white blood cells (neutrophils)- regular & frequent serum lab testing required
used for refractory schizophrenia
other atypicals:
Seroquel (quetiapine)
Risperdal (risperidone)
Geodone (ziprasidone) problem prolonged QT interval
Zyprexa (olanzapine) similar to clozapine w/o the risks of agranulocytosis, does have high risk for
seizures- common side effect is gain weight
both serotonin + dopamine antagonists
work on + & - symptoms
fewer EPS side effects, but there still may be
less risk for tardive dyskinesia
cost more
elderly w/ dementia r/t to psychosis increased risk for death when taking these meds
black box warning contraindicated
mostly death r/t to cardiac failure/sudden death or infection (pneumonia)
3.2 Substance abuse disorders
1.1 key terns
1.2 definitions of SUD
addiction- compulsive drug seeking or use.
Substance misuse- use of psychoactive substance (drug or alcohol) for a purpose other than that for which it was
intended & that causes physical, social , & psychologic harm.
Polysubstance abuse dependency abuse
1.3 USDEA categories
schedule 1 (high potential for abuse, no accepted medical use in treatment in the U.S ex. Heroin, mescaline)
schedule II (high potential for abuse but has currently accepted medical use w/ severe restrictions, may lead to
psychologic or physical dependence ex. Morphine, cocaine, codeine)
schedule III (potential for abuse less than for schedules I & II , currently accepted in medical practice, moderatelow dependence ex. Anabolic steriods, ketamine, thiopental)
schedule IV (low potential for abuse, current medical use, abuse may lead to limited dependence ex
benzodiazepines, ambien, sonata, meridia)
schedule V (only contains cough preparation w/ codeine up to 200 mg/100ml
so basically just know that the lower the number the higher the strictness/regulation of these substances/drugs and the higher
the risk for dependency.
1.4 neurobiological basis of addiction
drugs of dependence are categorized as depressants, stimulants, opiatesm hallucinogens, inhalants, & nicotine.
All drugs of abuse evoke a rapid release of neurochemicals that is followed by a reduced-from-baseline level of
neurotransmitter when the effect of the drug wears off creating a reward threshold & biologic need for craving
for more drug.
Drug serves as a reinforcer that increases the probability of a repeat behavior & the use of that substance.
Two sides of addiction:
light side (beginning use): the feel good neurotransmitters dopamine, serotonin, opiod peptides, & other
neurochemicals predominate.
Dark side (end use/withdrawal): neurotransmitters norepinephrine & corticotropin-releasing factor (CRF) as
well as the stress circuits are activated, which results in withdrawal symptoms. The individual then uses the
substance not to feel good but to prevent the physical & psychologic stress & discomfort.
Individuals w/ genetically greater neuroplastic potential for glutamate & dopamine production & activation
may be more prone to addiction
4 circuits:
reward: involves nucleus accumbens & ventral palladium (dopamine I.e light side)
Memory & learning: involve the amygdala & hippocampus
cognitive control: located in the prefrontal cortex & dorsal anterior cingulated cortex
motivation, drive, salience: orbital frontal cortex
all of these contribute to the initiation & continuation of substance use.
1 way path from amygdala to the frontal cortex frontal cortex does not have reciprocally direct communication
w/ the amygdala this frontal cortex (prioritization, organization, decision making) is unable to tell the amygdala
to stop.
1.5 epidemiological issues
50% for men whose father was an alcohol dependent
women are at higher risk than men for problems r/t to alcohol use, including organ damage & other problems.
Women begin problem drinking later in life than men develop physical & psychosocial problems in a faster,
often during child bearing years telescoping
native Americans have a high rate of alcoholism; Asians have low rate
the liver metabolizes alcohol by converting alcohol into acetaldehyde then into acetate & finally into carbon &
water. The enzyme responsible is ADH, alcohol dehydrogenase
Japanese, Chinese, & Koreans are missing this enzyme or have an inactive form. This is protective as
acetaldehyde increases in the blood quickly resulting in flushing, nausea, dizziness, & rapid HR. REMEMBER
this when we talk about Antabuse (disulfiram)
Co-morbid
people w/ mental illness have a greater risk of addiction & abuse PTSD, bipolar, anxiety, depression
medical comorbidites associated w/ drug & route of choice
vehicular accidents due to DUI & associated medical complications due to substance ingested.
1.6 substance abuse among special populations
women are more vulnerable to domestic violence & suicide
traditional programs do not address women's issues
binge drinking or frequent drinking problem in pregnant women
drinking in pregnancy is the leading known cause of preventable birth defects & learning difficulties
Fetal alcohol syndrome growth retardation, central nervous system involvement that results in mental
retardation & other learning difficulties, facial & other abnormalities occurs in 1 to 3 per 1000 live births.
Health
care professionals
10-20 % of nurses & 9% physicians are identified as having substance abuse problems
Older adults
at risk population for substance abuse
statistics do not reflect true extent of the population
70% of those 60 or older hospitalized for medical problems or accidents was r/t to alcohol
use to manage pain & loneliness
always look for it: falls, cognitive changes, assaults, & suicides may be correlated w/ alcohol abuse
Adolescents
p/t- family teaching guidelines: signs & prevention
bloodshot, red eyes, droopy eyelids
wearing sunglasses at inappropriate times
changes in sleep patterns (napping, insomnia)
unexplained periods of moodiness, depression, anxiety, or irritability
decreased interaction & communication w/ family
loss of interest in previous hobbies, sports & so on
change in friends; will not introduce new friends
decline in academic performance, drop in grades
loss of motivation & interest in school activities
change in peer group
disappearance of money or items of value
use of eye drops & mouthwash
unfamiliar containers or locked boxes
money missing from the house
prevention
ensure positive role modeling by parents & adults
reinforce the dangers of SU & teach positive behaviors
reinforce positive coping
establish limits & structure
anticipate pressures
provide life skills training
monitor media use
1.7 dual dx
Concurrent mental illness & drug abuse or dependence. Occur at the same time, or one follows the other,
eventually it becomes difficult to know which came first.
Antisocial personality disorder, bipolar, & schizophrenia highest w/ substance abuse.
Depression + bipolar disorder also have increased rates of substance abuse
HIV, HBV, HCV, TB sharing/reusing needles, syringes exposes risk.
1.8 alcohol use on American population
most widely used & abused substance
effects on the neurologic system
assess alcohol use in all cases of rapidly developing confusion.
Liver damage fatty liver
GI ulcers & inflammation
cardio high bp, LDL, triglycerides myocardial infarction & thrombosis wasting of heart muscle
immune system lowers white blood cells prone to infection
sleep fall asleep more quickly but depressed levels of REM & less stage 4 sleep glutamate increases causing
inability to sleep hangover symptoms
hormonal changes menstrual irregularity, decreased sperm production & motility, decreased ejaculate volume,
testosterone production & impotence.
Accidents DUI
1.9 intoxication, overdose , & withdrawal from:
CNS depressants: Alcohol, prescription opiates, anxiolytic drugs
Alcohol: significant psychologic/maladaptive changes that occur during or shortly after the ingestion of
alcohol.
Slurred speech, lack of coordination, unsteady gait, nystagmus, the breath smell of alcohol, impaired
attention & memory, coma or stupor.
Withdrawal symptoms: irritability, anxiety, agitation, insomnia, tremors, diaphoresis, delirium alcohol
DTs, seizures, possible death, begins 12-24 hrs after last ingestion
Prescription opiates: pain relievers, tranquilizers, stimulants, & sedatives
cognitive impairment + physical instability
Anxiolytic
drowsy, calming, & sedating effects to help w/ sleep disorders & symptoms of anxiety (common in all
CNS depressants)
lethal in overdose situations
when used as drug abuse, people often take them to reduce subjective unpleasant anxiety or to manage
withdrawal symptoms from other drugs (alcohol, cannabis, heroin, methadone, cocaine, amphetamines)
GHB illegal CNS depressant that relaxes/sedates the user often used in combination w/ alcohol
involved in date rapes, poisonings, overdoses, deaths.
Overdose in GHB Nausea, vomiting, headache, loss of consciousness & reflexes
overdose in benzodiazepines chlordiazepoxide (librium), diazepam (valium), lorazepam (Ativan),
clonazepam (klonopin), Alprazolam (xanax) disturb sleep patterns & cause changes in affect
withdrawal is lengthy, rapid discontinuation after habitual use of large amounts often causes seizures.
Live support measures: Naloxone (Narcan), lavage or dialysis, control of withdrawal seizures phenobarbital
tapering
Symptoms of CNS depressants withdrawal:
begins 12-16hrs after last dose
cravings
Abdominal cramps
diarrhea
Nausea & vomiting
bone & muscle pain
muscle spasm
tremor, chills, diaphoresis
treatment of CNS withdrawal: opioid substitution
methadone (dolophine) opioid agonist
buprenorphine (subutex) opioid agonist
naltrexone (re-via) blocks opioid receptors (antagonist) used for alcohol & opiate maintenance
decreases the craving & blocks the high or the effects of heroin & other opioids during
rehabilitation or overdose
**P/t's need to be wear alert bracelet **
revia is the oral form
vivitrol depot is the injection (last 1 month)
naltrexone implant is good for 2 months
suboxone (buprenorphine) in combination w/ naltrexone used for maintenance
treatment of alcohol acute intoxication or overdose
ABCs
Thiamine/high protein diet
nutrional support IV glucose
Clonidine (catapress) for tx of withdrawal symptoms
benzodiazepines such as ativan or librium (detox) (cross-tolerance)
Stimulants: cocaine, crack coaine, nicotine, caffeine, ephedrine, propanolamine, amphetamines, amphetamine-like
substances. Substances similar in action but diff. Chemical structure (diet pills).
Popular drugs of abuse b/c of their effects on brain
people get addicted to the sense of high energy, alertness, & well-being produced by them
effect the CNS mechanism HR & RESP.
raise bp & temp.
aggressive or violent behavior occurs w/ high dose use anxiety, paranoia, & psychotic episodes occur w/ the
abuse of & dependence on stimulants
cocaine most potent inhibits the uptake of dopamine in the brain & increases the dopamine receptors in
the brain reward system rapid dependency as it magnifies the pleasure sites of the brain increases
norepinephrine which causes vasoconstriction & cardiovascular stimulation.
Intoxication: Euphoria, feelings of impending doom, agitation/combativeness, hallucinations paranoia
confusion, seizures
withdrawal: headache, anxiety, restlessness, dreaming, cravings, depression (in cocaine high risk suicide),
decreased Bp, psychomotor retardation
nicotine has same intoxication, tolerance, withdrawal symptoms as other CNS stimulants
Steroids: anabolic androgenic steroid (r/t to male sex hormones)
enzymes & macrocytic anemia, carbohydrate-deficient transferrin (CDT). Urine drug screens within a
specified time frame qualitative.
1.11 plan of care nursing dx, goals & outcome, interventions
nursing dx
address orientation, level of anxiety, limitations in function (mental or physical) as a result of substance use,
social limitations, & dx r/t to altered family relationships.
The at risk for nursing dx relate to withdrawal, trauma, & relapse.
Be aware of difficulties w/ the 4 Ls love, livelihood, liver (health), & legal (problems)
outcome & goals
direct outcomes toward short or long-term changes in behaviors & lifestyles.
Maintain: safety & health, sobriety, his/her vital signs within normal range, normal fluid hydration.
Interventions
nurse focuses on treating & supporting the p/t through the drug withdrawal process detoxification. Focus on
education during stages of recovery.
FYI : cross-tolerance used to prevent withdrawal effects of drugs or alcohol. Ex. Ativan has a crosstolerance w/ alcohol b/c both affect the GABA receptors in the brain. It is used & gradually decreased to
manage withdrawal symptoms.
1.12 pharmacological agents used for withdrawal, detox, & maintenance
benzodiazepines used for alcohol withdrawal, detox & maintenance:
oxazepam (Serax), Lorazepam (ativan) for p/ts w/ severe liver failure
chlordizepoxide (Librium) long-acting for severe withdrawal symptoms
Acamprosate (campral) treats cravings that occur during early sobriety
Naltrexone (ReVia) used in conjunction w/ antidepressants it is an opioid antagonist
disulfiram (Antabuse) deterrent to alcohol use & abuse
thiamine (vitamin B1) for p/t's w/ severe alcohol withdrawal symptoms b/c of inadequate dietary intake
& malabsorption
Opioids
Methadone morphine & heroin addicts long acting used to treat withdrawal symptoms
L- -acetylmethadol (LAAM) longer acting opioid withdrawal
all these are used to suppress withdrawal symptoms.
Naltrexone opioid antagonist blocks opioids from reaching receptors in the brain.
Buprenorphine/naloxone (suboxone) naloxone (opioid antagonist) helps prevent abuse. Buprenorphine
helps w/ withdrawal symptoms & cravings
Buprenorphine (subutex) partial opioid agonist
Nicotine
varenicline (Chantix), bupropion (Zyban or Wellbutrin) reduce cravings
1.13 other treatment modalities
psychotherapy
active involvement in a recovery program in addition to participating in individual or group therapies.
Addresses p/t's addiction as well as any comorbid disorders or life threatining behaviors.
Relapse prevention
help p/ts avoud or take control of situations in which relapse is possible.
Practices what to do if relapse occurs & develops a comphrenisive plan to follow.
Harm reduction
techniques that help a person to change patterns of use to decrease the risk of harm & to adapt to a healthier
life-style.
Opiate replacements, needle-exchange programs
residential, half way house
provide living situations for c/ts who will need to totally reshape their lives, friends, social network, reconnect
w/ family & friends.
Outpatient care
teach the p/t to change & adjust to life w/o drugs while living in a real-life situation.
Community & faith based organizations
after-school programs, mentoring activities, sports
spirituality important to recovery for many individuals
object constancy (25 mo.)- ability to maintain a relationship regardless of frustration & changes in the
relationship (can comfort self even w/o mother present-use of representation-blanket).
Kernberg
tasks for ego development- distinguish b/t self & others. Integration of good & bad (self images, objectsother person 's image)
Splitting: inability to synthesize + & - aspects of self & others.
Idealization: idealizes person when needs are met.
Devaluation: devalues person when needs are unmet.
Lack of object constancy: inability to maintain the object (memory of good/bad characteristics) in one's
memory- leads to feelings of abandonment.
Projective identification-primitive type of projection
person projects an impulse on to another person (e.g., anger projected on to mother)
person continues to experience the impulse that they have projected to another (e.g, anger)
person fears the other person b/c they believe they have an impulse (e.g., anger)
person needs to control the other person
Borderline PD exhibit these issues.
1.5 biological factors r/t to the etiology of personality disorders
genetic twin studies- strong biological relationship b/t genetics & personality organization.
Focus on biological similarities b/t schizotypal PD & people w/ schizophrenia (similar symptoms/not as severe)
inability to correctly interpret environmental information- eye tracking behavior & backward maskingsuggests neurointegrative functioning deficits in the frontal lobes-associated w/ deficit traits of schizophreniasocial integrative functioning, isolation, detachment & inability to r/t to others.
Some biomarkers of neurochemical measures are evident w/ schizotypal borderline & antisocial PD
1.6 identify characteristics of p/ts in each of the 3 personality clusters A, B, C & unspecified personality disorders & 1.7
Cluster A
Paranoid, schizoid & Schizotypal make up the odd or eccentric cluster. These diagnosis are more likely to cooccur in an individual w/ a psychotic disorder.
Clinical symptoms:
interpret all experiences from the perspective that they have done damage by others.
Avoid relationships
reluctant to share info, guarded, suspicious, odd, detached
hypervigilant
Paranoid PD
distrustful & suspicious
difficulty adjusting to change
overly sensitive & argumentative
feelings of irreversible injury by others often w/ evidence
anxiety w/ difficulty relaxing
short temper
difficulty w/ problem-solving
unwilling to forgive even minor events
jealousy of significant other, often w/ evidence
Epidemiology: males more often than females; family members diagnosed w/ paranoid PD are at increased
risk; SUD common.
Schizoid PD
brief psychotic episodes in response to stress
lack of desire to socialize, enjoys solitude
lack of strong emotions
detached & self-absorbed affect
lack of trust in others
difficulty expressing anger
passive reactions to crisis
Epidemiology: males slightly more than females; increased prevalence w/ family members who have
schizophrenia or shizotypal PD.
Schizotypal PD
incorrect interpretation of external events/believes all things refer to self
superstitious w/ preoccupation w/ paranormal phenomena
belief in possession of magical control over others
constricted or inappropriate affect
anxiety in social situations
Epidemiology: generally seek treatment for anxiety or depression-not generally for PD;1st degree relatives of
persons w/ schizophrenia at increased risk; males slightly more than females.
Cluster B
Antisocial, borderline, Histrionic, & narcissistic PD constitute the dramatic & emotional cluster. Great deal of
co-morbidity w/ axis 1 disorders: substance abuse, mood & anxiety disorders.
Clinical symptoms
these disorders share dramatic, erratic, or flamboyant behavior
they share a high degree of overlap of symptoms
Co-morbidiy
substance abuse, mood disorders, depression, eating disorders, & anxiety disorders.
Antisocial PD
irresponsible
failure to honor financial obligations, plan ahead or provide children w/ basic needs.
Involvement in illegal activities
lack of guilt
difficulty learning from mistakes
initial charm dissolves in coldness, manipulation, & blaming others
lack of empathy
irritability
abuse of substance
Epidemiology: APD usually diagnosed before 18 yrs, Hx, conduct disorder before 15 years; males
(characteristics in early childhood) more than females (characteristics evident by puberty); Many in SUD
programs or prison; incidence higher among lower socioeconomic populations; impulsive behavior common;
approx. 1% of U.S population 18 yrs or older.
Borderline PD
recurrent suicidal &/or self-mutilating behaviors
poor impulse control & engage in impulsive acts (gambling, binging, spending money, reckless driving, unsafe
sex).
Negative or angry affect
feeling emptiness or boredom
difficulty being alone or feelings of abandonment
difficulty identifying self
perception of people all good or bad
intense & stormy relationship
Epidemiology: condition diagnosed in 1.6% of population 18+ yrs; often hx of physical or sexual abuse,
neglect, hostile or conflictual experiences, & early parental loss or separation; more females than males.
Histrionic PD
use of suicidal gestures & threats when feeling abandoned
fluctuation in emotion
attention-seeking & self-centered attitude
sexual seduction & flamboyance
attentiveness to own physiologic appearance
dramatic & impressionistic speech style
vague logic; a lack of conviction in arguments, often switching sides
shallow emotional expression
craving for immediate satisfaction
complaints of physical illness; somatization
Epidemiology: females more than males
Narcissistic PD